Hepatosplenic Trunk Research Articles

Unraveling Variations in Celiac Trunk and Hepatic Artery by CT Angiography to Aid in Surgeries of Upper Abdominal Region.

Understanding of variations in the course and source of abdominal arteries is crucial for any surgical intervention in the peritoneal space. Intricate surgeries of the upper abdominal region, such as hepato-biliary, pancreatic, gastric and splenic surgeries, require precise knowledge of regular anatomy and different variations related to celiac trunk and hepatic artery. In addition, information about the origin of inferior phrenic artery is important in conditions such as hepatocellular carcinoma and gastroesophageal bleeding management. The present study gives an account of anatomical variations in origin and branching pattern of celiac trunk and hepatic artery by the use of CT (computed tomographic) angiography. The study was performed on 110 (66 females and 44 males) patients in a north Indian population. Results unraveled the most common celiac trunk variation as hepatosplenic trunk with left gastric artery, which was observed in 60% of cases, more common in females than in males. Gastrosplenic and hepato-gastric trunk could be seen in 4.55% and 1.82% cases respectively. Gastrosplenic trunk was more commonly found in females, whereas hepato-gastric trunk was more common in males. A gastrosplenic trunk, along with the hepato-mesenteric trunk, was observed in 1.82% cases and was more common in males. A celiacomesenteric trunk, in which the celiac trunk and superior mesenteric artery originated as a common trunk from the aorta, was seen only in 0.91% of cases, and exhibited an origin of right and left inferior phrenic artery from the left gastric artery. The most common variation of hepatic artery, in which the right hepatic artery was replaced and originated from the superior mesenteric artery, was observed in 3.64%, cases with a more common occurrence in males. In 1.82% cases, the left hepatic artery was replaced and originated from the left gastric artery, which was observed only in females. Common hepatic artery originated from the superior mesenteric artery, as observed in 1.82% cases, with slightly higher occurrence in males. These findings not only add to the existing knowledge apart from giving an overview of variations in north Indian population, but also give an account of their correlation with gender. The present study will prove to be important for various surgeries of the upper abdominal region.

Anomalous Anatomical Variations of Coeliac Trunk: A Cadaveric Study.

BackgroundThe celiac trunk, celiac axis or celiac artery is the first major abdominal branch of the aorta. Anatomical variations of the coeliac trunk and along with the other branches of the abdominal aorta result from changes in the ventral segmental arteries supplying the digestive tube during foetal development. Panagouli performed a systemaic review and proposed a new classification describing all celiac trunk variations through a systematic review. Knowledge of the celiac trunk anatomy and any variations is clinically relevant in esophageal, gastroduodenal, hepatic, biliary and pancreatic angiographic and surgical procedures. The purpose of this study is to report the pattern of the celiac trunk and its variations in a sample of the Indian population as per the Panagouli classification.MethodsThis was an observational study done in the period from September 2018 to October 2020 in the department of surgery of Gandhi Medical College & Hamidia Hospital, Bhopal, India. Cadaveric dissection was carried out in the department of forensic medicine and toxicology after obtaining approval from the ethical committee.ResultsWe did our study in 50 cadavers to look for further anatomical variations. The most common form found was true tripus Halleri. The rest of the variations noted included false tripus Halleri. Other variations were hepatosplenic trunk with left gastric artery arising from the aorta (6%), hepatosplenic trunk with no normal left gastric artery (2%), Hepatosplenic trunk with gastromesenteric trunk (2%) and coeliacomesenteric trunk (2%).ConclusionsThe congenital anomalies of the coeliac trunk have been long recognized and are of significant clinical importance as they may surprise the surgeon during surgery. Also, the wide spectrum of anomalies present in this area can be recognized by modern radiological evaluations like multi-detector helical computed tomography, MRI and magnetic resonance cholangiopancreatography (MRCP). Having the knowledge of these anatomical variations in mind may prevent inadvertent injuries during routine and complex hepato-pancreaticobiliary procedures.

English

Major sources of the vascular supply of the gastrointestinal tract are the celiac trunk (CT) and superior mesenteric artery (SMA) which are the main proximal branches of the abdominal aorta. The CT gives rise to three branches normally as follows: left gastric artery (LGA), common hepatic artery (CHA) and splenic artery (SA). The branching pattern of the CT is considered as the most literature explained anatomical pattern.1 After the CT, the abdominal aorta gives the second named branch as superior mesenteric artery. Vascular variations of the celiac trunk and superior mesenteric artery are common and had been described earlier.2 These variations are caused due to the aberrant embryological development of splanchnic arteries. The incidence of hepato-spleno-mesenteric trunk has been reported by various authors as 0.68 %,3 0.7 %,4 0.3 %,5 0.4 %,6 or 1 %.7 The importance of knowledge of these variations lies in preplanning of invasive surgical techniques, organ transplantation, diagnosis, prevention, and management of some metastatic tumours and to overcome the catastrophic consequences like bowel ischemia due to common trunk.8 Hence a better understanding of these anatomical variations is considered vital for surgeons or radiologists for appropriate planning and conduction of surgical procedures or interventions.9 Most of the anatomical variations in abdominal aorta branches are asymptomatic and incidental findings while imaging for other aetiologies. But the identification of such vascular variations is of utmost importance in clinical practice. The Hepatospleno-mesenteric trunk [HSMT] is one of those variations and was less frequently reported. The authors describe a case report of the hepato-spleno-mesenteric trunk which was incidentally detected in the multi detector computed tomography study of the abdomen of a 54-year-old male patient who had been diagnosed to have chronic liver disease and hepatic encephalopathy. The origin of the HSMT [with a diameter of 11mm] occurs from the abdominal aorta at the level of the L2 vertebral body and is divided into the hepatosplenic trunk [diameter of 7 mm] and superior mesenteric artery [diameter of 7.5 mm] after coursing for a length of 28 mm. The hepatosplenic trunk ascends superiorly for a length of 20 mm and divided into two terminal branches: common hepatic (6 mm) and splenic artery (6 mm).

Anatomical variants of coeliac trunk in Polish population using multidetector computed tomography angiography.

Multidetector computed tomography angiography (MDCTA) has become a major part in evaluation of normal anatomy and its variants in patients undergoing operative or interventional procedures. The purpose of this study was to assess the frequency of anatomical variation of coeliac trunk in patients undergoing MDCTA of the abdominal aorta. A descriptive, retrospective study was carried out on MDCTAs performed from January 2014 till January 2020 in Polish patients. Coeliac trunk was studied and normal and anatomical variations were noted according to Adachi's classification. All patients with abnormalities affecting the vessels or a history of any vascular abnormality were excluded from the study. Out of total 1000 patients, hepatogastrosplenic trunk was found in 93.0%. True and false types of trifurcation were observed. Hepatosplenic trunk was found in 2.8%, coeliacomesenteric trunk in 1.1%, hepatomesenteric trunk in 1.7% gastrosplenic trunk was found in 1.4%. We have not observed hepatosplenomesenteric trunk. The type and knowledge of anatomy is of prime importance for an optimum preoperative planning in surgical or radiological procedure. MDCTA allows minimally invasive assessment of arterial anatomy with high quality three-dimensional reconstruction images.

Coeliac trunk and its anatomic variations: a cadaveric study.

Coeliac trunk (CT) is the first major visceral branch of the abdominal aorta. The aim of this work was to present the CT division pattern and its anatomical variants in a sample of Polish population. Coeliac trunk dissection was performed in 50 adult cadavers in the Department of Anatomy, Jagiellonian University Medical College. Cadavers of Polish subjects were included. Cadavers with previous upper abdominal surgery, abdominal trauma, disease process that distorted arterial anatomy or signs of putrefaction were excluded. CT variations, accessory vessels, and vertebral level of origin were described. CT patterns were reported according to the Adachi classification. This study was reviewed and approved by the local Ethics Committee. Coeliac trunk consisting of the left gastric, common hepatic and splenic artery (type 1 according to the Adachi classification) was found in 82% of cadavers. The true tripod was found in 20% and the false one in 80%. Additional vessels were also found: greater pancreatic from the splenic artery and left inferior phrenic from the left gastric artery, which accounted for 2% sections. Type 2 according to the Adachi classification (i.e. the hepatosplenic trunk) was found in 16% of the sections. Other types of CT were not observed. The level of origin was found to be at the inter-vertebral disc between T12 and L1 in all of the cases. Based on the analysis of the sectional material of the Department of Anatomy, it was found that the typical visceral segmental division is approximate to that observed by Adachi in its classification, whereas the second type of CT was twice as frequent and no other, less frequent types were found.

The prevalence of anatomical variants of the coeliac trunk and renal arteries on contrast-enhanced abdominal computed tomography scans at Dr George Mukhari Academic Hospital.

BackgroundAnatomical variations of the coeliac trunk and renal arteries should be radiologically reported as they affect the surgical approach and subsequent outcome in patients.ObjectivesThe aim of this study was to determine the prevalence of anatomical variations of the coeliac trunk and renal arteries and whether there is a relationship between the occurrence of these variations at Dr George Mukhari Academic Hospital.MethodArterial phase abdominal computed tomography (CT) or CT abdominal angiograms performed during January and December 2017 were analysed. The variations of the coeliac trunk and renal arteries were classified according to accepted classification systems and expressed as a percentage of the study population.ResultsA normal classical coeliac trunk was present in 82.2% and a non-classical pattern was present in 9.7%. The most common variation of the coeliac trunk other than the non-classical pattern was a hepatosplenic trunk, which was present in 3% of the study population. A normal right and left renal artery was present in 88.2% and 83.7%, respectively. The most common variations of the renal arteries were bilateral hilar arteries seen in 3.4% on the right and 9.1% on the left. Renal artery variations were more prevalent on the left than on the right. Concurrent variations of both the right and the left renal arteries were present in 2.4% and variations of both the coeliac trunk and renal arteries were present in 5% of the study population.ConclusionThe most common variation of the coeliac trunk in this study is comparable to other studies in non-African populations. Concurrent vascular variations between the renal arteries and between the coeliac trunk and renal arteries may co-exist.

Variations of the celiac trunk investigated by multidetector computed tomography: Systematic review and meta-analysis with clinical correlations.

In recent years multidetector computed tomography (MDCT) has been used to investigate vascular anatomy for scientific and diagnostic purposes. These studies allow for much larger sample sizes than traditional cadaveric studies. The aim of this research was to perform a systematic review and meta-analysis on studies investigating the variations of the celiac trunk using MDCT. Major medical databases were used to find studies investigating celiac trunk anatomy using MDCT. Extracted information included demographic details, number of normal celiac trunks, and number of each variant celiac trunk. Using a random effects meta-analysis the pooled prevalence of each variation was calculated. A total of 36 studies from 14 countries and four continents were included in the meta-analysis. The total number of subjects included was 17,391. The total prevalence of variant celiac trunks was 10.85%. The different types of celiac trunk variations with their prevalences were: gastrosplenic trunk (3.46%), hepatosplenic trunk (3.88%), hepatogastric trunk (0.24%), absent celiac trunk (0.28%), celiacomesenteric trunk (0.46%), hepatosplenomesenteric trunk (0.26%), gastrosplenomesenteric trunk (0.07%), and celiacomesenteric anastomosis (0.09%). A total of 61 cases (0.19%) were either not described or not described adequately to be included in our classification. Major variations of the celiac trunk are not uncommon and should be anticipated before radiological and surgical interventions. Knowledge of celiac trunk anatomy is important in hepatopancreatobiliary surgery, transplantology, and interventional radiology.

Identification of Celiac Trunk Variations using Multi-Detector Computed Tomographic Angiography

Introduction: Variation in celiac trunk is common and has importance in preoperative planning to reduce the risk of accidental vascular injuries during surgical and radiological intervention. Our aim was to measure the prevalence of coeliac trunk types and describe its different variations using MDCT angiography among patients in Hospital Tengku Ampuan Afzan (HTAA), Kuantan. Materials and method: A retrospective cross sectional study was conducted. Computed Tomographic Angiography (CTA) images were retrieved from July till December 2017. Images were reconstructed in 3D Volume Rendering (VR) format using workstation and reviewed for the normal and anatomical variations of the celiac trunk. The variations were classified using Uflacker’s classification. The results were calculated using IBM SPSS statistic version 22. Results: A total of 140 cases were found, from which 23 were excluded. Mean age was 57.3 years and male/female percentage was 65.8/34.2. Anatomical variation of the CT was found in 54 (46.2%) cases. The most common variation was the origin of inferior phrenic artery (IPA) from the CT in 21 (17.9%) cases followed by celiac-colic trunk in 15 (12.8%) cases. However, 31 (26.5%) cases displayed variations not described in Uflacker’s classification. They include celiaco-phrenic trunk, coexistence of IPA with other Uflacker’s variations, Buhler arc, accessory hepatic artery from the CT and coexistence of celiac-colic trunk with gastro-splenic and hepato-splenic trunk in one case each. Conclusion: Accurate knowledge and identification of anatomical variations in CT is crucial before undergoing any surgical or invasive imaging procedure. This can help surgeons and interventional radiologists to prevent accidental vascular injuries and perform a safe procedure.

Morphological characteristics of the celiac-mesenteric trunk

The present paper describes the morphological characteristics of 12 celiac-mesenteric trunk cases highlighted by angiography-computed tomography (CT), characteristics met only in male cases (1.82% of the cases). In relation to the vertebral column, the origin of the trunk was found in the the upper half of the L1 vertebra – intervertebral disk between L1 and L2 vertebrae. At the level of its origin from the aorta, the celiac-mesenteric trunk had an external diameter with values ranging from 8.7-13.4 mm, the aortic ostium of the celiac-mesenteric had a vertical diameter ranging from 8.8 to 13.1mm, the horizontal diameter values ranging from 8.8 to 11.2mm. At the level of its origin, the celiac-mesenteric trunk and the aortic wall had an angle with values ranging from 30.0o to 90.2o. The length of the celiac-mesenteric trunk had values ranging from 21.8 to 42.5 mm, most frequently met values were ranging from 30.7 to 33.5mm. At the level of its bifurcation, the celiac-mesenteric trunk had an angle with values ranging from 82.2 to 120,7, most frequently met values were over 90o. The celiac trunk resulted from the celiac-mesenteric bifurcation had an exterior diameter of 6.2 – 10.2 mm, values that in relation to exterior diameter the celiac-mesenteric originated, it represented 65.57 – 92.47% of its external diameter. The celiac trunk up to the end of its ramification had a length with values ranging from 6.3 to 16.8 mm. In all cases being a hepatosplenic trunk, the left gastric aorta originated in the abdominal aorta in 10 cases (83,3% of the cases) and in the other 2 cases, the left gastric aorta originated in one case under the end bifurcation of the celiac trunk whereas the other case in the celiac-mesenteric trunk, before its end bifurcation. The superior mesenteric artery resulting from the ramification of the celiac-mesenteric trunk had an external diameter with values ranging from 4.4 to 8.5 mm that represented 44.44 – 85.06% of the external diameter of the celiac-mesenteric trunk.

Variations in the branching pattern of the celiac trunk and its clinical significance.

Celiac trunk is the artery of foregut, arising from the abdominal aorta at the level of T12/L1 vertebral body. It extends approximately 1.5 to 2 cm horizontally forwards before dividing into three branches: left gastric, common hepatic, and splenic arteries. Out of the three ventral branches of abdominal aorta, celiac trunk is more prone to have variations. During routine dissection of abdomen for undergraduate students we found some rare variations in the branching pattern of the celiac trunk. Absence of celiac trunk with hepatomesenteric trunk, quadrifurcation with dorsal pancreatic artery arising from it, quadrifurcation with middle colic artery arising from it, left inferior phrenic artery arising from celiac trunk, highly tortuous splenic artery supplying distal 1/3rd of transverse colon and hepatosplenic trunk. Knowledge of such variations is essential for liver and pancreas transplantations, pancreaticoduodenectomy, radiological abdominal interventions, laproscopic surgeries, and in trauma of the abdomen.

Common and separate origins of the left and right inferior phrenic artery with a review of the literature.

In a 94-year-old male cadaver, upon which routine dissection was being conducted, a rare variation was found in the gastrophrenic trunk (GPT), the common trunk of the left gastric artery (LGA), right inferior phrenic artery (RIPA), and left inferior phrenic artery (LIPA); the GPT arises from the abdominal aorta. A hepatosplenic trunk accompanied the variation. In this variation, the RIPA first branched from the GPT and then to the LIPA and LGA. Variations in the common trunk of the LIPA and RIPA in the GPT are common, but to our knowledge, a variation (separate inferior phrenic artery in the GPT) similar to our findings has not been previously reported. We discuss the incidence and developmental and clinical significance of this variation with a detailed review of the literature. Knowledge of such a case has important clinical significance for invasive and non-invasive arterial procedures. Therefore, different variations concerning the LGA and inferior phrenic artery should be considered during surgical and non-surgical evaluations.

A case of a hepatosplenomesenteric trunk combined with a hepatocolic trunk

An understanding of the variations in the blood supply of the foregut and midgut are of critical importance to surgeons performing transplants, liver and biliary surgery, resection of tumors and various gastrointestinal procedures, as well as to interventional radiologists engaged in vessel embolization. During the dissection of a 95-year-old female cadaver as part of a course in medical gross anatomy at the University of California at Davis a rare series of vascular variations were observed. The left gastric artery arose independently from the abdominal aorta at the location of a typical celiac trunk. The common hepatic artery and splenic artery branched from a common vessel originating from a hepatosplenomesenteric trunk. Just inferior to the hepatosplenic trunk a hepatocolic trunk, which gave rise to an accessory right hepatic artery, dorsal pancreatic artery and a wandering mesenteric artery, branched from the superior mesenteric artery. This rare combination of clinically relevant variations was likely due to the abnormal partitioning and regression of the primitive splanchnic arteries during embryonic development.

Anatomical variations of the celiac trunk and hepatic arterial system: an analysis using multidetector computed tomography angiography.

ObjectiveTo analyze the prevalence of anatomical variations of celiac arterial trunk (CAT) branches and hepatic arterial system (HAS), as well as the CAT diameter, length and distance to the superior mesenteric artery.Materials and MethodsRetrospective, cross-sectional and predominantly descriptive study based on the analysis of multidetector computed tomography images of 60 patients.ResultsThe celiac trunk anatomy was normal in 90% of cases. Hepatosplenic trunk was found in 8.3% of patients, and hepatogastric trunk in 1.7%. Variation of the HAS was observed in 21.7% of cases, including anomalous location of the right hepatic artery in 8.3% of cases, and of the left hepatic artery, in 5%. Also, cases of joint relocation of right and left hepatic arteries, and trifurcation of the proper hepatic artery were observed, respectively, in 3 (5%) and 2 (3.3%) patients. Mean length and caliber of the CAT were 2.3 cm and 0.8 cm, respectively. Mean distance between CAT and superior mesenteric artery was 1.2 cm (standard deviation = 4.08). A significant correlation was observed between CAT diameter and length, and CAT diameter and distance to superior mesenteric artery.ConclusionThe pattern of CAT variations and diameter corroborate the majority of the literature data. However, this does not happen in relation to the HAS.

Coeliac trunk and common hepatic artery variations in children: an analysis with computed tomography angiography.

Understanding the coeliac trunk (CeT) and hepatic artery anatomy is important not only in preventing iatrogenic injuries but also in planning surgical procedures in children. Therefore, the aim of this study is to analyse the prevalence of CeT and common hepatic artery (CHA) variations in the paediatric population. One hundred and seventy-four children who underwent abdominal multidetector computed tomography (MDCT) angiography, either because of trauma or liver transplantation, were analysed retrospectively. The patterns of CeT, CHA and their variant branches were revealed and compared with previous studies involving adults. A total of 157 (90.2%) of the 174 patients had normal CeT anatomy, whereas 17 (9.8%) had variations. Five types of CeT variations were identified according to Song's classification in which 'hepatosplenic trunk + left gastric artery + superior mesenteric artery' was the most prevalent. One hundred-twelve (64.4%) of the 174 patients had normal CHA anatomy; however, 62 (35.6%) had variations. Six types of CHA variations were identified according to Michel's and Hiatt's classification. The most common was 'replaced left hepatic artery originating from left gastric artery'. The prevalences of CeT and hepatic artery variations are high in children, as they are in older patients. Awareness of these variations is important in terms of avoiding iatrogenic injury and in promoting surgical procedure planning for liver transplantation or abdominal tumour surgery.

Variation in the branching pattern of celiac trunk: a case report

AbstractArterial supply for the derivatives of foregut in the abdomen is provided by the branches of the celiac trunk. Celiac trunk is the first ventral branch of abdominal aorta and usually branches into splenic, common hepatic and left gastric arteries. Variations in the branching pattern of celiac trunk are common but in most of the people, they remain asymptomatic and go unnoticed. A good knowledge of these anatomical variations is important for surgeons undertaking various surgeries in the abdominal region and will help to minimise the complications related to abdominal surgery. Clinicians and radiologists should also be aware of any variations in the vascular pattern of the celiac trunk before performing angiographic examinations. In the current case, the celiac trunk divided into two branches; left gastric artery and hepato-splenic trunk. The hepato-splenic trunk further divided into splenic and common hepatic arteries. The common hepatic artery trifitrcated into proper hepatic, gastroduodenal and accessory hepatic arteries. Hepatic artery proper divided into right and left hepatic arteries. The accessory hepatic artery was tortuous and was as large as the left hepatic artery. It gave origin to the right gastric artery and entered the liver through left end of porta hepatis.

The celiac axis revisited: anatomic variants, pathologic features, and implications for modern endovascular management.

The celiac axis (CA) and its branches are critically important arteries that supply blood to the vital solid and hollow abdominal viscera of the foregut. There are many potential anatomic configurations, with up to half the population having a variation from the classic pattern of the CA bifurcating into the hepatosplenic trunk and left gastric artery. These configurations result from permutations in the fusion of the paired dorsal aortas during the first trimester. Despite the short length of the CA, it is affected by a wide range of pathologic conditions, including mesenteric ischemia due to intrinsic occlusion (secondary to causes such as atherosclerosis or thromboembolic events) and extrinsic compression from masses or the median arcuate ligament. Symptoms of mesenteric ischemia are nonspecific and include postprandial abdominal pain and weight loss; thus, the underlying pathologic condition may be found only when being sought specifically. More unusual pathologic conditions include dissection, aneurysms, and vascular malformations. Awareness of the pathologic conditions that affect the CA is important for both diagnostic and interventional radiologists. Early recognition and treatment of CA disease may prevent catastrophic hemorrhage and bowel infarction. Both endovascular and surgical approaches to treatment are greatly enhanced by correct identification of arterial anatomic variants; catheter angiography, computed tomographic angiography, and magnetic resonance angiography can facilitate detection of these variants. Knowledge of the different anatomic permutations is essential to guide endovascular procedures, such as hemorrhage control, transarterial interventional oncologic therapy, and treatment of visceral artery aneurysms. Online supplemental material is available for this article.

Anatomical variations of the coeliac trunk in the homogeneous Polish population.

The abdominal vessels show a number of abnormalities and pathologies knowledge of which is important during open as well as laparoscopic surgeries. One of the most common vessels which pattern has many variations is the coeliac trunk. The present study was undertaken on homogeneous population to assess morphology of the coeliac trunk and to evaluate the possible variability of its branches. Standard abdominal multidetector computed tomography examinations were performed on a total of 1569 patients diagnosed by 2 radiologists independently; in case of doubts common assessment was performed. The coeliac trunk followed the classic pattern in 92.7% of the cases (1455/1569 of patients). The gastrosplenic trunk was detected in 4.1% of cases (64/1569); the hepatosplenic trunk in 2.2% of cases (34/1569); the coeliac-mesenteric trunk was observed in 0.5% of cases (8/1569); the hepatogastric trunk in 0.2% of cases (4/1569); the splenomesenteric trunk was detected in 0.1% of cases (2/1569). In the next 0.1% the coeliac trunk was absent. The hepatosplenomesenteric and the coeliac-colic trunk were not observed in the study population. Vascular anatomical abnormality is usually asymptomatic hovewer, its preoperative knowledge is helpful to reduce complications like vascular bleeding when dissecting the hapato-pancreatic region. The coeliac trunk and its branches can be fast and easy evaluated in computed tomography exams performed due to various symptoms from abdominal cavity.

Celiomesenteric and hepatosplenomesenteric trunks: characterization of two rare vascular anomalies with CT.

The purpose of this retrospective investigation is to characterize and illustrate the appearances of celiomesenteric trunk (CMT) and hepatosplenomesenteric trunk (HSMT) using CT with three-dimensional volume-rendering with attention to the proximal branching patterns. We also correlate our results with an embryologic model and assess the accuracy of radiologists in recognizing these entities. CT studies on 36 adult subjects with CMT and 10 with HSMT were analyzed to determine the proximal branching patterns and lengths of the common vascular trunks. The official reports in appropriately selected cases were reviewed to ascertain if the interpreting radiologists recognized the anomalies. Two types of CMT were found. In 29 of 36 cases (81%), the CMT bifurcated into the celiac trunk and superior mesenteric artery (Type A CMT), while in 7 cases the left gastric artery (LGA) arose from the CMT proximal to the hepatosplenic trunk and superior mesenteric artery (Type B CMT). Type A trunks (mean length = 10.4 mm) were significantly shorter (p = 0.007) than Type B trunks (mean length = 17.8 mm). Short common trunks (less than 1.0 cm) were only seen with Type A CMT. Branching patterns in all 10 cases of HSMT were identical with no short common trunks. The CMT was not mentioned in the radiology reports in 88% of the cases assessed. The location of the LGA origin distinguishes the two variants of CMT and differentiates CMT from HSMT. These anomalies are easily overlooked during evaluation of routine clinical cases.

Variant anatomy of the celiac trunk –review of literature with a case report

Variations of arteries in the abdomen frequently include the celiac, renal and gonadal arteries. These anatomic variations are often responsible for variety of clinical conditions and pose major considerations during surgeries. Thorough knowledge of normal and variant anatomy of major unpaired arteries originating from the abdominal aorta is necessary to accomplish successful abdominal operations and to avoid complications. During routine dissection we came across a variation in the celiac trunk. Instead of normal trifurcation of the celiac trunk, we observed three separate trunks arising from the abdominal aorta: gastrophrenic trunk, hepatosplenic trunk and hepatophrenic trunk. The incidence and developmental as well as clinical significance of these variations having crucial surgical importance are discussed with a detailed review of the literature.

Variation and research progress of celiac trunk branch

Celiac trunk is a wide and short ventral branch. It originates from the anterior abdominal artery at the level of L1 vertebra, and divides into three branches: the left gastric, common hepatic and splenic arteries, supplying the upper abdominal organs such as stomach, liver, spleen, pancreas, and duodenum. However, there are many types of branches variations. The branches of celiac trunk are classified into several types. We establish a classification of variation type according to the origin of left gastric, common hepatic and splenic arteries, which includes hepatogastrosplenic trunk type, hepatosplenic trunk type, hepatogastric trunk type, gastrosplenic trunk type, and the others include hepatosplenomesentery trunk type, hepatogastrospleno-mesentery trunk type, hepatogastrosplenocolonic trunk type, hepatogastrosplenopancreatic trunk type, gastrospenic trunk plus hepatomesentery trunk type, hepatogastrosplenoic left liver trunk type, hepatogastro-splenopancreatoduodenal trunk type, hepatogastric trunk plus hepatosplenic trunk type. Development of celiac trunk variation type was introduced based on the classification of Lipshutz, Adachi, Michels and Zhang Nianjia. Mastering the types of branches variations is necessary for us to perform the upper abdominal operations safely and effectively.